Provider Demographics
NPI:1427741610
Name:EDWARDS, CLAYTON D
Entity type:Individual
Prefix:
First Name:CLAYTON
Middle Name:D
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8457 EAGLES LOOP CIR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5337
Mailing Address - Country:US
Mailing Address - Phone:772-631-7376
Mailing Address - Fax:
Practice Address - Street 1:9200 CONROY WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-8423
Practice Address - Country:US
Practice Address - Phone:407-612-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist